2014;20(3):274-278. The authors concluded that high digit ratio in men with gynecomastia may tend to be a marker of over-expression of ER and PR. Completely autologous platelet gel in breast reduction surgery: A blinded, randomized, controlled trial. 2009;7(2):114-119. Photographs were taken pre-operatively and 1, 3, 6, and 12 months post-operatively. Mannu GS, Sudul M, Bettencourt-Silva JH, et al. The vacuum-assisted breast biopsy system is an effective strategy for the treatment of gynecomastia. Aesthetic Plast Surg. 2001;76(5):503-510. The average amount of tissue removed from an average weight woman (within the 70 to 74.9 kg weight band) in this study was 600 g per breast, with a range of 502 g to 700 g of tissue removed per breast. J Am Coll Surg. Reduction mammaplasty: Defining medical necessity. For additional language assistance: Chemical exfoliation for acne (eg, acne paste, acid), Mastectomy, partial (e.g., lumpectomy, tylectomy, quadrantectomy, segmentectomy), Diagnostic mammography, including computer-aided detection (CAD) when performed, Photodynamic therapy by external application of light to destroy premalignant and/or malignant lesions of the skin and adjacent mucosa (eg, lip) by activation of photosensitive drug(s), each phototherapy exposure session, Photodynamic therapy by external application of light to destroy premalignant lesions of the skin and adjacent mucosa with application and illumination/activation of photosensitizing drug(s) provided by a physician or other qualified health care professional, per day, Basic life and/or disability examination that includes: Measurement of height, weight, and blood pressure; Completion of a medical history following a life insurance pro forma; Collection of blood sample and/or urinalysis complying with "chain of custody" protocols; and Completion of necessary documentation/certificates, Weight management classes, non-physician provider, per session, Mononeuropathies of upper limb [upper extremity paresthesia], Gangrene, not elsewhere classified [tissue necrosis], Non-pressure chronic ulcer of skin of other sites, Hypertrophy of breast [symptomatic-causing significant pain, paresthesias, or ulceration], Other specified disorders of breast [soft tissue infection]. Gland Surg. Fan L, Yang X, Zhang Y, Jiang J. Endoscopic subcutaneous mastectomy for the treatment of gynecomastia: A report of 65 cases. margin-bottom: 38px; Plast Reconstr Surg. In the case of breast reduction, however, for insurance purposes, it . The control group was not followed longitudinally or treated according to any protocol to ensure that they received optimal conservative management; conclusions about the lack of effectiveness of conservative management were based on their responses to a questionnaire about whether subjects tried any of 15 conservative interventions, and whether or not they thought these interventions provided relief of symptoms. Kasielska-Trojan A, Danilewicz M, Antoszewski B. In a review on Surgical treatment of primary gynecomastia in children and adolescents, Fischer et al (2014b) concluded that surgical correction of gynecomastia remains a purely elective intervention. Plastic surgery for teenagers briefing paper. (This refers to actual breast tissue only; any fatty tissue removed doesn't count.) Breast reduction outcome study. These investigators analyzed the incidence of occult breast cancer and high-risk lesions in reduction mammoplasty specimens of women with previous breast cancer. The effectiveness of surgical and nonsurgical interventions in relieving the symptoms of macromastia. No necrosis, systemic infection, or muscle paralysis was reported. Evidence-based clinical practice guideline: Reduction mammaplasty. There were 18 out of 415 studies eligible to review. These investigators concluded that their findings do not support the use of completely autologous platelet gel to improve outcomes after reduction mammoplasty. No author listed. 1997;185(6):593-603. Mannu and colleagues (2018) stated that idiopathic gynecomastia is a benign breast disorder characterized by over-development of male breast tissue. Ann Plastic Surg. Prostate Cancer Prostatic Dis. The characteristics of patients as well as the curative effects between the 2 groups were analyzed. This will be computed based on your body area. 2018;24(6):1043-1045. Yao and co-workers (2019) described an innovative method for the operative treatment of gynecomastia -- vacuum-assisted minimally invasive mastectomy. 2021;147(5):1072-1083. 2000;45(6):575-580. .headerBar { The authors concluded that with proper patient selection, reduction mammoplasty can be performed safely on older patients. list-style-type: upper-alpha; Aetna considers molecular susceptibility testing for breast and/or epithelial ovarian cancer ("BRCA testing") medically necessary once per lifetime in any of the following categories of high-risk adults with breast or epithelial ovarian cancer (adapted from guidelines from the U.S. Preventive Services Task Force (for He and associates (2011) examined the safety and feasibility of vacuum-assisted biopsy device in the treatment of gynecomastia. } Plast Reconstr Surg. Current concepts in gynaecomastia. .strikeThrough { Principles of breast re-reduction: A reappraisal. Reduction mammoplasty: Criteria for insurance coverage. Townsend: Sabiston Textbook of Surgery. Oxfordshire NHS Trust. Annu Rev Med. Compared with the open surgery group, the vacuum-assisted breast biopsy group had significantly smaller scar sizes left after the operation (5.5 1.3 cm versus 0.8 0.2 cm, p < 0.001), and shorter hospital stay time (5.5 2.4 days versus 3.1 1.6 days, p < 0.001). American College of Obstetricians and Gynecologists (ACOG), Committee on Adolescent Health Care. The nipple-areola complex was re-positioned in 60 % of patients (n = 54). Key takeaways: Health insurance does not cover cosmetic breast reduction, but it usually does cover breast reduction surgery that is considered medically necessary. A study reporting on a survey of health insurer policies on breast reduction surgery (Nguyen et al, 2004) found that no insurer medical policies could be supported by the medical literature. The investigators found that comorbid conditions increased across obesity classifications (p < 0.001), with significant differences noted in all cohort comparisons except when comparing class I to class II (p = 0.12). Reduction mammaplasty: The need for prospective randomized studies. Hermans, BJ, Boeckx, WD, De Lorenzi, F, Vand der Hulst, RR. Patients were randomized to receive the gel applied to the left or right breast after hemostasis was achieved; the other breast received no treatment. Only 8 (9.9 %) patients did not have a complete resolution following tamoxifen therapy, of which 2 underwent subsequent surgical resection of their symptomatic gynecomastia. A cohort study of breast cancer risk in breast reduction patients. Subjects responses were compared to an age-matched comparison group of women, although no further details about how this comparison group were provided. Treating providers are solely responsible for medical advice and treatment of members. Exposure to partners using estrogen containing vaginal creams; Cancer chemotherapy (alkylating agents, methotrexate, vinca alkaloids, imatinib, combination chemotherapy), Androgen receptor blockers - bicalutamide, 5 reductase inhibitors - finasteride, dutasteride, Angiotensin converting enzyme inhibitors (captopril, enalapril), Calcium channelblockers(diltiazem, nifedipine, verapamil), Anabolic steroids(e.g., in body builders). The average age of the studied individuals was 25.7 years (SD = 7.8); ER and PR expression was detected in breasts, and digit ratios were calculated in patients with idiopathic gynecomastia. The data were retrospectively analyzed for demographics, operative and histopathology reports, oncological treatment, and post-operative follow-up. Surgical treatment of gynecomastia by vacuum-assisted biopsy device. 2021;74(11):3128-3140. Collins ED, Kerrigan CL, Kim M, et al. In contrast, tobacco use and BMI were associated with worse breast reduction outcomes. There are alsoseveral earlier, smaller studies that found reductions in symptoms and improvements in quality of life after reduction mammoplasty (Glatt et al, 1999; Bruhlmannand Tschopp, 1998; Blomqvist et al, 2000; and Behmand et al, 2000). Arlington Heights, IL: ASPS; May 2011. Mental health care professionals may be consulted to address psychological distress from gynecomastia. Moreover, these researchers stated that further studies are needed within the common gynecomastia population managed by plastic surgeons to examine the clinical and economical utility of this intervention before a recommendation for its ubiquitous adoption in plastic surgery can be made to continue improving outcomes for high-risk gynecomastia patients. Copyright Aetna Inc. All rights reserved. The mean incidence of gynecomastia was 70 % in the high-risk population examined representing prostate cancer patients on estrogen or anti-androgen therapy. 2016;20(3):256-260. Clinical Policy: Reduction Mammoplasty and Gynecomastia Surgery - WellCare Covered items may include: A manual or standard electric pump (non-hospital grade) while you are pregnant or for the duration of breastfeeding. Estrogens and estrogen like drugs,including: Drugsthat enhance estrogen formation, including: Drugs which inhibit testosterone synthesis, including, Drugs that inhibit testosterone action, including. In total there were 306 women in the 3 trials, and 505 breasts were studied (254 drained, and 251 who were not drained). 1998;26(1):61-65. Jansen DA, Murphy M, Kind GM, Sands K. Breast cancer in reduction mammoplasty: Case reports and a survey of plastic surgeons. Plastic Reconstr Surg. My Experience of Having Breast Reduction Surgery - Health Policy Statement 6d: Aesthetic surgery procedures. For many patients the psychological impact of the disease is substantial. Pseudo-gynecomastia refers to excessive fat tissue or prominent pectoralis muscles. Philadelphia, PA: W.B. Breast asymmetries: A brief review and our experience. Narula HS, Carlson HE. However, these medications should be reserved for those with no decrease in breast size after 2 years. Measurement of plasma gonadotrophins, human chorionic gonadotropin (hCG), testosterone, estradiol, and dehydroepiandosterone sulphate (DHEAS). Furthermore, no serious complications were observed in vacuum-assisted breast biopsy group. Vacuum-assisted minimally invasive mastectomy was performed successfully in all cases, with no residual glands or adipose tissue observed on US. As explained below, the studies used to support the arguments for the medical necessity of breast reduction surgery are poorly controlled and therefore subject to a substantial risk of bias in the interpretation of results. Raispis T, Zehring RD, Downey DL. Drains were used significantly less by surgeons performing greater than or equal to 20 BBRs (p = 0.02). The following factors were independently associated with any surgical complications: morbid obesity (odds ratio [OR], 2.1; P < .001), active smoking (OR, 1.7; P < .001), history of dyspnea (OR, 2.0; P < .001), and resident participation (OR, 1.8; P = .01) while factors associated with major complications included active smoking (OR, 2.7; P < .001), dyspnea (OR, 2.6; P < .001), resident participation (OR, 2.1; P < .001), and inpatient surgery (OR, 1.8; P = .01). The Breast: Comprehensive Management of Benign and Malignant Diseases. Horm Res Paediatr. Please check your insurance policy to see whether breast reduction is a covered procedure. Plast Reconstr Surg. z-index: 99; The requirement for coverage is that the amount of breast tissue to be removed has to be enough to improve your symptoms or function. list-style-type: decimal; The surgeon estimates that at least the following amounts (in grams) of breast tissue, not fatty tissue, will be removed from each breast, based on the member's body surface area (BSA) calculated using theMosteller formula. They have argued that removal of even a few hundred grams of breast tissue can result in substantial pain relief. They investigated effects of age on 30-day surgical outcomes for reduction mammoplasty with a goal of improving patient care, counseling, and risk stratification on 3537 patients. Reduction mammoplasty has been performed to relieve back and shoulder pain on the theory that reducing breast weight will relieve this pain. For medical Aetna Coverage Denial - 2nd Appeal (They said I'm overweight) Many men with breast enlargement are found to have pseudo-gynecomastia. 1995;95(6):1029-1032. Bertin ML, Crowe J, Gordon SM. Is there a rationale behind pharmacotherapy in idiopathic gynecomastia? For example, if the body surface area is 1.40 m2 , the estimated breast tissue to be removed should at least be 324 grams. A total of 244 out of 1,628 patients with the average age of 23.13 years. For these reasons, there is insufficient evidence to support the use of reduction mammoplasty, without regard to the size of the breasts or amount of breast tissue to be removed, as a method of relieving chronic back, neck, or shoulder pain. Post-operative complications included 1 case of hematoma, but no nipple necrosis, local skin necrosis, or skin buttonhole occurred. In Type I (idiopathic) gynecomastia, the adolescent presents with a tender, firm mass beneath the areola. Follow-up ranged from 2 months to 3 years. Breast reduction surgery is considered cosmetic for all indications not listed in section I, A. Philadelphia, PA: WB Saunders Company; 2008; Ch 73. 2015;49(6):311-318. Administration of Benefits and Transition Responsibilities CPT Codes 19316 & 19318 - Mastopexy & Reduction No significant changes have been made to the Hoyos and colleagues (2021) stated that male chest definition surgery and patients complaining of breast tissue over-growth have been increasing in recent decades. Because of their inherently subjective nature, pain symptoms are especially prone to placebo effects. Plast Reconstr Surg. Arlington Heights, IL: ASPRS; 1987. The average interval between primary and secondary surgery was 14 years (range of 0 to 42 years). Three review authors undertook independent screening of the search results. The surgeon must also certify that a certain weight of breast tissue (based on Aetna's table) will be removed in every breast, and not entirely fatty tissue. Karamanos et al (2015) identified their study as the largest sample on breast reduction in the literature, in which age and surgeon specialty did not correlate with negative results. 18th ed. ASPS clinical practice guideline summary on reduction mammaplasty. Qu and colleagues (2020) examined the effectiveness of vacuum-assisted breast biopsy systems for the treatment of gynecomastia. Second, it is the burden of the proponent of an intervention to provide reliable evidence of its effectiveness, not the burden of ones whoquestion the effectivenessan intervention to provide definitive proof of ineffectiveness. text-decoration: underline; Ann Plast Surg. It was also found that only 3 % of subjects reported that they had no aesthetic motivation for surgery. Does Aetna Cover Breast Reduction? | HelpAdvisor.com Am J Infect Control. Reduction mammoplasty: Cosmetic or reconstructive procedure? World J Surg. Patients with abnormal histopathology could not be pre-operatively identified based on demographics. #closethis { Coding Reduction mammoplasty for asymptomatic members is considered cosmetic. 2007;356(5):479-485. Breast reduction for symptomatic macromastia. Surg Laparosc Endosc Percutan Tech. border: none; This conclusion is based primarily upon the Breast Reduction Assessment of Value and Outcomes (BRAVO) study, which is described in several articles (Kerrigan et al, 2001; Kerrigan et al, 2002; Collins et al, 2002). the nipple-areola complex can be elevated by de-epithelialization rather than recreating or developing a new pedicle; breast tissue is removed where it is in excess, usually inferiorly and laterally; the resection is complemented with liposuction to elevate the bottomed-out inframammary fold; and. Furthermore, there is insufficient evidence that surgical removal is more effective than conservative management for pain due to gynecomastia. Well-designed, prospective, controlled clinical studies have not been performed to assess the effectiveness of surgical removal of modest amounts of breast tissue in reducing neck, shoulder, and back pain and related disability in women. Fischer S, Hirsch T, Hirche C, et al. OL OL OL OL LI { See Appendix for Table 1. The majority (87.7 %) of cases presented with accompanying mastalgia. The authorsleave the reader with the conclusionthat decisions about the medical necessity of breast reduction surgery in symptomatic women should be left entirely to the surgeon's discretion. The authors concluded that treatment of gynecomastia by the Mammotome device was distinctive, practicable in manipulation, safe, and could achieve excellent cosmetic results. Nelson JA, Fischer JP, Wink JD, Kovach SJ 3rd. Level of Evidence = IV. Imahiyerobo TA, Pharmer LA, Swistel AJ, Talmor M. A comparative retrospective analysis of complications after oncoplastic breast reduction and breast reduction for benign macromastia: Are these procedures equally safe? Early complications were rare (6.1%), with superficial skin and soft tissue infections accounting for 45.8% of complications. Leclere FM, Spies M, Gohritz A, Vogt PM. 1998;101(2):361-364. /* aetna.com standards styles for templates */ These preliminary findings need to be validated by well-designed studies. The safety, efficacy, complications, and patient satisfactions were recorded during post-operative follow-up periods. This may lead to additional scarring and additional operating time. The American Society for Plastic Surgery (2011) advises to delay surgery until breast growth ceases: Although waiting may prolong the psychological awkwardness, it is advisable to delay surgery until breast growth ceases in order to achieve the best result. This is similar tothe American College of Obstetricians and Gynaecologists'2011 Guidelines forAdolescent Health Care chapter on breast concerns in adolescents, which states regarding breast hypertrophy: Preferably, treatment should be deferred until breast growth has been completed. Dancey A, Khan M, Dawson J, Peart F. Gigantomastia--a classification and review of the literature. Merkkola-von Schantz and colleagues (2017) stated that contralateral reduction mammoplasty is regularly included in the treatment of breast cancer patients. The study consisted of 329 breast cancer patients, who underwent symmetrizing reduction mammoplasty between 1/2007 and 12/2011. Medical therapy should be aimed at correcting any reversible causes (e.g., drug discontinuance). You must be at least 18 years old or show completed breast growth (no change in breast size over at least a year) to qualify for Aetna breast reduction coverage. Little is known about the effect of surgical treatment on the psychological aspects of the disease. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. Breast pumps. Reduction mammoplasty has also been used for relief of pain in the back, neck and shoulders. Choban PS, Flancbaum L. The impact of obesity on surgical outcomes: A review. Wound drainage after plastic and reconstructive surgery of the breast. padding: 15px; 2001;107(5):1234-1240. The investigators reported that subjects who were of normal weight were as likely to report benefit from reduction mammoplasty as subjects who were over-weight. A detailed physical examination, including testicular examination. To calculate body surface area (BSA) see:BMI and BSA (Mosteller) Calculator;orBSA (m2) = ([height (in) x weight (lb)]/3131)(denotes square root), BSA (m2) = ([height (cm) x weight (kg)]/3600)(denotes square root). PDF Breast Reduction Surgery and Gynecomastia Surgery - Aetna Last Review01/04/2023. Reduction mammaplasty: An outcome study. Plast Reconstr Surg. Nelson JA, Fischer JP, Chung CU, et al Obesity and early complications following reduction mammaplasty: An analysis of 4545 patients from the 2005-2011 NSQIP datasets. Grooving where the bra straps sit on the shoulder. 2017;35:157-161. 1995;95(1):77-83. The author concluded that the current level of evidence on this subject was very low and future studies, examining the impact of the surgical intervention for gynecomastia on psychological domains, are greatly needed. Management of gynecomastia should include evaluation, including laboratory testing, to identify underlying etiologies. The authors concluded that low-dose radiotherapy to the male breast might be a safe and effective strategy to prevent gynecomastia incidence or recurrence in high-risk patients. Also, there was no correlation between PR expression and 2D: 4D. Fat grafting volume ranged from 50 to 300 cc in each pectoral muscle. Breast reconstruction/breast enlargement Breast reduction/mammoplasty Excision of excessive skin due to weight loss Gastroplasty/gastric bypass Aetna considers associated nipple and areolar reconstruction and tattooing of the nipple area medically necessary. The authors concluded that breast re-reduction can be performed safely and predictably, even when the previous technique is not known; and 4 key principles were developed: Language services can be provided by calling the number on your member ID card. The median complication rate was 12.4 % with no major complications, such as neoplastic, pulmonary, or adverse cardiac outcomes. Aesthetic Plast Surg. Lonie S, Sachs R, Shen A, et al. The authors specified the value of these study results was in the identification of morbid obesity as a significant predictor of overall morbidity and active smoking as a strong predictor of major surgical morbidity. A population-level analysis of bilateral breast reduction: does age affect early complications? A total of 3 RCTs were identified and included in the review out of 190 studies that were initially screened; all evaluated wound drainage after breast reduction surgery. The primary outcome was the difference in wound drainage over 24 hours. list-style-type: lower-alpha; Breast Reconstructive Surgery - Medical Clinical Policy Bulletins - Aetna In a within-patient, randomized, patient- and assessor-blinded, controlled study, Anzarut et al (2007) evaluated the use of completely autologous platelet gel in 111 patients undergoing bilateral reduction mammoplasty to reduce post-operative wound drainage. border-radius: 4px; PDF Procedures, programs and drugs you must precertify - AmeriBen } Chadbourne EB, Zhang S, Gordon MJ, et al. Washington, DC: ACOG; 2011:121-122. In these cases, breast reduction for men may take 2 to 3 hours. Prepubertal gynecomastia linked to lavender and tea tree oils. PDF A look at new changes coming to E&M and breast coding in 2021